Growth and growth biomarker changes after adenotonsillectomy: systematic review and metaanalysis

Objective: To determine the effect of adenoidectomy and/or tonsillectomy (``adenotonsillectomy'')upon growth and growth biomarkers, in the context of sleep disordered breathing (SDB). SDB in children, primarily due to adenotonsillar hypertrophy, increases the risk of growth failure. Design: Systematic review and meta-analysis. PubMed, ERIC and Cochrane Reviews databases from January 1980 to November 2007 were searched for studies reporting: pre/post-adenotonsillectomy height and weight changes as percentage increased or decreased, raw data, z scores or centiles, or: IGF-1 and/or IGFBP-3 serum-level changes as z scores or raw data. For anthropometrics, the meta-analysis included studies presenting z scores or centiles. Setting: Observational studies. Patients: Otherwise healthy children, not selected for obesity. Main outcome measures: Pre/post-surgery changes in standardised height and weight, and IGF-1 and IGFBP-3. Results: Of 211 citations identified, 20 met systematic review criteria. SDB was an enrolment criterion in 13 of the studies, and one of several enrolment criteria in three. Meta-analysis findings for pre/post-surgery changes were: standardised height: 10 studies, 363 total children, pooled standardised mean differences (SMD)= 0.34 (95% CI 0.20 to 0.47); standardised weight: 11 studies, 390 total children, pooled SMD= 0.57 ( 95% CI 0.44 to 0.70); IGF-1: 7 studies, 177 total children, pooled SMD= 0.53 ( 95% CI 0.33 to 0.73); IGFBP- 3: 7 studies, 177 total children, pooled SMD= 0.59 ( 95% CI 0.34 to 0.83). Conclusions: Standardised height and weight, and IGF-1 and IGFBP- 3 increased significantly after adenotonsillectomy. Findings suggest that primary care providers and specialists consider SDB secondary to adenotonsillar hypertrophy when screening, treating and referring children with growth failure.